Do you often feel anxious? Struggling to concentrate at work? Do you wake up drenched in sweat? Welcome to a phase that is frequently overlooked and often chaotic.

This transitional stage, marked by menopause symptoms but not yet completed, was once brushed off as a fleeting hormonal shift. Today, it’s increasingly acknowledged as a challenging and disruptive decade during which significant changes occur within the body and mind.

Emotional ups and downs, migraines, fluctuations in heart rhythms, urinary tract infections—an array of symptoms can leave many feeling unacknowledged. Fortunately, as our grasp of hormonal health evolves, emerging treatments are providing essential relief.

Nonetheless, there’s no shortage of noise. Social media is awash with advice on remedies, ranging from dietary supplements to intricate exercise routines. What genuinely benefits you, and what is merely a waste of time and money?

The answer depends on your personal experience of the perimenopause phase. During this time, estrogen levels fluctuate unpredictably, accompanied by declines in progesterone and testosterone, impacting everything from bone density and muscle strength to cognitive function and cardiovascular health.

Despite the fact that half the population goes through this transition, its significance is often underestimated. “Menopause marks a pivotal moment in a woman’s life—physically, emotionally, and socially,” states Christina del Toro Badsa, a physician and expert in hormonal health based in Atlanta, Georgia. “However, many women belong to the ‘sandwich generation,’ caring for both children and aging parents while their own well-being is often neglected.”

These symptoms go beyond personal struggles; they can have far-reaching social implications. According to a survey by British charities regarding welfare, one in four women considers leaving their job due to menopausal symptoms. In the U.S., a 2025 study estimates that the costs associated with reduced working hours or premature retirement due to menopause amount to $1.8 billion annually.

In terms of solutions, the UK’s National Institutes of Health (Nice) identifies hormone replacement therapy (HRT) as the first-line treatment for those over the age of 40. However, despite its efficacy, the adoption remains inconsistent, and its use in the U.S. has dramatically fallen over the last quarter-century. This decline is partly due to long-standing fears surrounding side effects revealed in two studies. A significant HRT trial in 2002 was halted after early results suggested an increased risk of breast cancer, heart attacks, and strokes. A follow-up in 2003 estimated that HRT was linked to 20,000 breast cancer cases in the following decade.

While these trial findings were not incorrect, they had limitations and were misunderstood. Media reports, for instance, focused on women over 60. Later trials indicate that the age at which women start HRT significantly influences their breast cancer risk. For example, five years after stopping HRT, women who have taken HRT for less than 5 years show no increased risk of breast cancer.

Context is key. According to the British Menopause Society, women aged 50-59 using HRT (both estrogen and progestogen) for up to 14 years may see an additional 10 breast cancer diagnoses per 1,000. However, this “minor risk” must be evaluated against the substantial reduction in endometrial cancer risk provided by HRT. This risk is comparable to several lifestyle factors, such as obesity, which adds 10 additional breast cancer diagnoses per 1,000 women in the same age group, while consuming 4-6 units of alcohol daily increases cases by eight. In short, while HRT slightly raises the likelihood of breast cancer diagnosis, it is not substantial compared to various other lifestyle choices.

Advantages of HRT

Furthermore, HRT offers several benefits, including lowering the risk of cardiovascular diseases and reducing fracture rates. Initial research suggests that estrogens may be crucial in assisting the brain with glucose metabolism regulation, potentially explaining fatigue and memory lapses during perimenopause due to estrogen depletion affecting glucose processing. Additionally, studies by Roberta Brinton from the University of Arizona indicate that HRT may provide some protection against Alzheimer’s disease—a notion that remains controversial.

“All menopause guidelines indicate that hormone replacement therapy is the most evidence-based treatment for perimenopausal symptoms,” asserts Louise Newson, a physician and member of the UK government’s menopause task force.

Still, HRT isn’t suitable for everyone. Some women may have additional risk factors that prevent their use of HRT, such as prior history of lupus or blood clots, while others may hesitate due to perceived associated risks. For instance, researchers like Karyn Flick from the University of Wisconsin-Milwaukee are studying highly selective estrogen receptor drugs. Unlike current HRTs, which activate a broad range of estrogen receptors, these drugs target only those linked to protective effects, such as inhibiting the growth of breast and ovarian cancer. Initial studies suggest this method could be more effective than existing treatments.

Nice also recommends cognitive-behavioral therapy (CBT) as a frontline strategy during the perimenopausal phase. Clinical trials indicate that CBT can effectively diminish hot flashes and night sweats.

On the topic of hot flashes, drug developers are making strides. In 2023, the FDA approved Fezolinetant, the first non-hormonal medication designed for this issue. It operates by blocking NK3 receptors in the brain that control the body’s internal thermostat in low estrogen conditions. “This medication works quickly and effectively,” explains Alyssa Dweck, a consultant gynecologist and chief medical officer at Bonafide Health, a US-based company specializing in menopause products. The downside is the high cost, unsure insurance coverage in the U.S., and the necessity for regular liver monitoring due to potential side effects.

A more promising alternative may be Elinzanetant, a similar drug that received approval in July from the UK’s regulatory agency. It targets both NK1 and NK3 receptors, and early trials suggest it not only reduces moderate to severe hot flashes, but also alleviates sleep disorders without inducing liver toxicity.

Is Increasing Protein Intake Necessary During Menopausal Transition?

Medical intervention is just one component of the solution. Dietary changes can also be beneficial. Many influencers advocate for “increased protein intake,” which may hold some truth during the perimenopause. Although most individuals meet their protein requirements with a balanced diet, hormonal shifts during perimenopause can lead to bone and muscle loss, causing some women to gain weight for unclear reasons.

Arthur Conigrave from the University of Sydney suggests that the disparity between the body’s protein needs and actual intake could be a contributing factor. In a 2022 study, he and his colleagues found that as muscle protein breaks down, the brain compels a person to eat more to restore protein levels. However, without dietary adjustments to boost protein percentage, many end up eating more carbs and gaining weight.

The Conigrave research team posits that during the perimenopausal phase, women might need to boost their daily protein intake by approximately 0.1 to 0.2 grams per kilogram of body weight. For a person weighing 70 kg (about 155 lbs), that’s an extra 7g to 14g of protein each day—equivalent to a large egg or a cup of edamame.

Do Supplements for Perimenopause Actually Deliver Results?

Despite the hype, scientific evidence supporting supplements for perimenopausal symptom relief is sparse. A 2021 review identified only one extract, Cimicifuga racemosa, or Black Cohosh, as having considerable evidence for effectiveness; research suggests it may alleviate anxiety, irritability, and hot flashes. This might be due to increased serotonin levels, but results vary widely. Safety remains uncertain. Vitamin B6 may lessen hot flashes and protect against cognitive decline, while maintaining optimal vitamin D levels can bolster mood and immune function. Nevertheless, these supplements may not yield transformative effects.

“Certain vitamins and supplements can alleviate some symptoms, but they cannot replace missing hormones or provide the long-term health benefits that HRT offers,” notes Newson. Multiple studies have indicated that HRT reduces the long-term risk of heart disease and diabetes.

Moreover, there’s an increasing interest in the microbiome and its alterations during menopause. A recent review of current research demonstrated that while probiotics show beneficial effects on perimenopause-related bone health, hot flashes, psychological symptoms, and vaginal dryness, many studies still require more robust design to minimize bias.

Should I Focus on Weights or Cardio?

Finally, there’s the question of the most effective exercise regimen to combat the effects of perimenopause. Is it necessary to hit the pavement, or is strength training the better approach? A review of studies from 2015 to 2022 confirmed that weight training during perimenopause enhances strength, bone density, and metabolic health, but it’s still uncertain if this method outperforms other forms of exercise.

In terms of social media “advice,” proceed with caution. Regulators are tightening restrictions on misleading claims, but this area still possesses a Wild West atmosphere. Significant attention and funding are necessary to further understand the conditions affecting women.